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APPLICATIbals FOR CONSTRUCT mud PERMIT <br />Eno Evorgr"n TO BE COMPLETED IN INK —PLEASE PRINT <br />CITY OF <br />everett BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS U ELECTRIC <br />259.8810 <br />(:I DEMOLITION ❑ COMBINATION kf BUILDING L) MECHANICAL. <br />everett <br />e. <br />❑ PLUMBING ❑ SIGN <br />OWNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />T &o&#,jq <br />Co,I P.o. <br />'Tbo1C 3707 <br />A15 cF-76, <br />ZC47 <br />SA/A, 92rLY, <br />3VL_ rFyl <br />s <br />.al, <br />TENANT <br />MAIL 900AFSS <br />CITY <br />ZIP <br />PHONE <br />S H'»T E AS <br />o w li c a- <br />ARCHITECTORDESIGNER <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />TIFF AUlrid <br />Co.�oIS'- <br />(4' Ayis,W., <br />L-VCTtyr, iy4, 98L•y <br />m0-9r7y <br />GENERAL CONTRACTOR <br />MAILAODRL'SS <br />CNY <br />ZIP <br />PHONE <br />LICENSEE <br />A5 <br />D4A.1NS/L <br />MECHANICAL CONT RACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE( <br />PLUMBINOCONTOACTOR MAIL ADDRESS CITY ZIP PHONE LICENSEE <br />CLASS OF WORK <br />O NEW Ll ADDITION IX ALTERATION CJ REPAIR ❑ DEMOLITION U WOODSTOVEIFRPL INSERT ❑ BUILDING RELOCATION <br />CONTRACT PRICE OF WORK ( O <br />CONTACT PERSON AND PHONE NO. <br />I-Cb R f A: —3s <br />DESCRIBE WORK AND SOUARE FOOTAGE INJVbXLVED <br />VDaTiii6Arted rx#,qiff FOrC GrC. <br />PROPOSED USE OF BUILDING <br />f (, <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND VNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAD. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />ILl'/!�F^•' "- //�,/I <br />PROJECTADDRESS ��D`�'li� <br />p0 WIC (NO 1� <br />APPLICANTS CITY BUSINESS LICENSE NO. AND BUSINESS NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />, <br />A/C-A/HNDLG UNITS-H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN). <br />I <br />UNIT HEATERS-B.T.U. M <br />; <br />SHOWER <br />' <br />CLOTHES DRYERS <br />I <br />KITCHEN SINK A DISP <br />; <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />I <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />; <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />I <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING_ <br />ROOF DRAINS-RAINLEADERS <br />' <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAH, ETC.) <br />I <br />i <br />I <br />T <br />I <br />I <br />I <br />r <br />I <br />I <br />SUB TOTAL $ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />' <br />PERMIT { <br />I <br />TOTAL FEE $ <br />TOTAL FEE S <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SE70ACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />27&2 7 <br />4 <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />i S <br />TYPE OF CONTS. ALLOWABLE <br />TYPE Or CONST. ACTUAL <br />E l#P <br />NBMPYIHIW UT116 <br />, <br />PLUMBING <br />1 ' <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />i <br />ADDITIONAL PLAN CHECK <br />OCCUPAIICY LOAD FIRE SPRNKLERS RED HEIGHTLIMITATION <br />OTHER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />Stu <br />INTAKE BY <br />I IS APPROVED BY CITY OF EVERETT <br />PUBLIC WORKS <br />j1 LOCAL SALESIS31 <br />� 1 TAX CODE IS 3105 <br />TOTAL <br />S S 9 ; 7 3 <br />